6 The cause is unknown, 6 but it has been suggested that inadequacy or rupture of the interchondral fibrous attachments of the anterior ribs can allow subluxation of the costal cartilage tips, impinging on the intercostal nerves. There is a tender spot on the costal margin and pressing on this reproduces the pain. Lower rib pain syndrome (also termed painful rib syndrome, rib-tip syndrome, slipping rib, twelfth rib and clicking rib) typically presents with lower chest or upper abdominal pain. 4 It differs from the rarer Tietze’s disease, which typically involves only one area with associated painful, localised swelling. 5 Patients with costochondritis typically present with multiple areas of tenderness without swelling over the costochondral or costosternal junctions, palpation of which reproduces their pain. In one general practice sample, costochondritis, also known as costosternal syndrome and anterior chest wall syndrome, was the most common specific cause of anterior musculoskeletal chest pain, with a prevalence of 13%.
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